Unité de Santé Internationale, Centre de recherche du Centre hospitalier de l'Université de Montréal, Édifice Saint-Urbain 3875 rue Saint-Urbain 5ième étage, Montreal, QC, H2W 1V1, Canada.
Matern Child Health J. 2011 Oct;15(7):1081-7. doi: 10.1007/s10995-010-0655-y.
The West African country of Mali implemented referral systems to increase spatial access to emergency obstetrical care and lower maternal mortality. We test the hypothesis that spatial access- proxied by travel time during the rainy and dry seasons- is associated with in-hospital maternal mortality. Effect modification by caesarean section is explored. All women treated for emergency obstetrical complications at the referral hospital in Kayes, Mali were considered eligible for study. First, we conducted descriptive analyses of all emergency obstetrical complications treated at the referral hospital between 2005 and 2007. We calculated case fatality rates by obstetric diagnosis and travel time. Key informant interviews provided travel times. Medical registers provided clinical and demographic data. Second, a matched case-control study assessed the independent effect of travel time on maternal mortality. Stratification was used to explore effect modification by caesarean section. Case fatality rates increased with increasing travel time to the hospital. After controlling for age, diagnosis, and date of arrival, a travel time of four or more hours was significantly associated with in-hospital maternal mortality (OR: 3.83; CI: 1.31-11.27). Travel times between 2 and 4 h were associated with increased odds of maternal mortality (OR 1.88), but the relationship was not significant. The effect of travel time on maternal mortality appears to be modified by caesarean section. Poor spatial access contributes to maternal mortality even in women who reach a health facility. Improving spatial access will help women arrive at the hospital in time to be treated effectively.
西非国家马里实施了转诊制度，以增加获得紧急产科护理的空间机会，并降低产妇死亡率。我们检验了以下假设，即空间可达性（以雨季和旱季的旅行时间来表示）与院内产妇死亡率相关，并探讨了剖宫产术的效应修饰作用。马里卡伊转诊医院接受紧急产科并发症治疗的所有妇女均被认为有资格参加研究。首先，我们对 2005 年至 2007 年期间在转诊医院治疗的所有紧急产科并发症进行了描述性分析。我们按产科诊断和旅行时间计算了病死率。关键知情人访谈提供了旅行时间。医疗登记册提供了临床和人口统计学数据。其次，一项匹配的病例对照研究评估了旅行时间对产妇死亡率的独立影响。分层用于探索剖宫产术的效应修饰作用。病死率随着到医院的旅行时间的增加而增加。在控制年龄、诊断和入院日期后，旅行时间超过 4 小时与院内产妇死亡率显著相关（OR：3.83；CI：1.31-11.27）。旅行时间在 2 至 4 小时之间与产妇死亡率增加的几率相关（OR 1.88），但无统计学意义。旅行时间对产妇死亡率的影响似乎受到剖宫产术的修饰。即使在到达医疗机构的妇女中，空间可达性差也会导致产妇死亡。改善空间可达性将有助于妇女及时到达医院，以便得到有效治疗。
